Maintenance of Shoulder Health and Function After Spinal Cord Injury
| Status: | Completed |
|---|---|
| Conditions: | Hospital, Hospital, Orthopedic |
| Therapuetic Areas: | Orthopedics / Podiatry, Other |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/17/2018 |
| Start Date: | April 2012 |
| End Date: | July 2017 |
Southern California Spinal Cord Injury Model System: A Randomized Clinical Trial to Evaluate Two Prevention Programs for Maintenance of Shoulder Health and Function After Spinal Cord Injury
The purpose of this study is to determine if a shoulder exercise program can prevent the
onset of shoulder pain and improve community participation in persons who have a spinal cord
injury (SCI). Upon entry into the study patients will have pain-free shoulders and will be
followed for 3 years to determine rate of shoulder pain development. Patients will learn a
simple shoulder home exercise program and will be instructed on techniques to protect their
shoulder during wheelchair propulsion, transfers and activities of daily living. Patients
will be instructed to perform the home exercise program 3 days per week. Two types of
treatment (training) delivery approaches that have been documented to reduce chronic shoulder
pain will be compared. The rate of shoulder pain development for the two groups will be
compared to the rate of shoulder pain development in the historical control group. The
investigators hypothesize that the rate of shoulder pain development will be lower in the
experimental treatment groups compared to the historical control group. Any differences
between the two treatment delivery approaches for the experimental treatment groups will help
to provide guidelines for the most effective delivery approach of a shoulder pain prevention
program.
onset of shoulder pain and improve community participation in persons who have a spinal cord
injury (SCI). Upon entry into the study patients will have pain-free shoulders and will be
followed for 3 years to determine rate of shoulder pain development. Patients will learn a
simple shoulder home exercise program and will be instructed on techniques to protect their
shoulder during wheelchair propulsion, transfers and activities of daily living. Patients
will be instructed to perform the home exercise program 3 days per week. Two types of
treatment (training) delivery approaches that have been documented to reduce chronic shoulder
pain will be compared. The rate of shoulder pain development for the two groups will be
compared to the rate of shoulder pain development in the historical control group. The
investigators hypothesize that the rate of shoulder pain development will be lower in the
experimental treatment groups compared to the historical control group. Any differences
between the two treatment delivery approaches for the experimental treatment groups will help
to provide guidelines for the most effective delivery approach of a shoulder pain prevention
program.
All persons are at risk for shoulder pain from a shoulder injury or rotator cuff injury.
Persons with SCI are at a greater risk because of the increased use of their shoulders.
Lifestyle changes following SCI place a large demand on an individual's shoulders. Pushing a
wheelchair, transferring, and performing pressure relief raises are three common activities
that put added strain on the shoulders. In addition to these activities, reaching from a
wheelchair can put strain on the shoulder because many environments are not ideally set up
for wheelchair users. These new stressors are believed by the medical community to lead to
shoulder pain. The prevalence of shoulder pain for persons with spinal cord injury is 30-70%.
Untreated, shoulder pain may lead to additional losses in function and community mobility.
Previous research shows that shoulder exercises along with education on how to improve one's
technique for wheelchair propulsion, transfers, and weight relief raises can significantly
reduce chronic shoulder pain and improve quality of life. The investigators aim to not only
reduce existing shoulder pain, but also to prevent the onset of new pain.
The current study will teach the same 4 simple shoulder strengthening exercises performed in
the prior study to patients with healthy shoulders. Half of the patients will receive 2
sessions of one-to-one training with a physical therapist, and the other half will receive 4
sessions of training combined with an interactive education program on techniques to protect
their shoulder in a class format led by a physical therapist and a peer mentor with a spinal
cord injury. Patients will be followed for 3 years to learn if they develop shoulder pain.
Persons with SCI are at a greater risk because of the increased use of their shoulders.
Lifestyle changes following SCI place a large demand on an individual's shoulders. Pushing a
wheelchair, transferring, and performing pressure relief raises are three common activities
that put added strain on the shoulders. In addition to these activities, reaching from a
wheelchair can put strain on the shoulder because many environments are not ideally set up
for wheelchair users. These new stressors are believed by the medical community to lead to
shoulder pain. The prevalence of shoulder pain for persons with spinal cord injury is 30-70%.
Untreated, shoulder pain may lead to additional losses in function and community mobility.
Previous research shows that shoulder exercises along with education on how to improve one's
technique for wheelchair propulsion, transfers, and weight relief raises can significantly
reduce chronic shoulder pain and improve quality of life. The investigators aim to not only
reduce existing shoulder pain, but also to prevent the onset of new pain.
The current study will teach the same 4 simple shoulder strengthening exercises performed in
the prior study to patients with healthy shoulders. Half of the patients will receive 2
sessions of one-to-one training with a physical therapist, and the other half will receive 4
sessions of training combined with an interactive education program on techniques to protect
their shoulder in a class format led by a physical therapist and a peer mentor with a spinal
cord injury. Patients will be followed for 3 years to learn if they develop shoulder pain.
Inclusion Criteria:
- spinal cord injury
- at least 2 years duration post spinal cord injury and no greater than 20 years
duration post spinal cord injury
- at least 18 years of age
- free of shoulder pain that interferes with daily activities or requires medical
intervention at the time of enrollment in the study
- a total score on the "Wheelchair User's Shoulder Pain Index" of 10 or less
- adequate arm strength and movement to perform the shoulder exercise program
Exclusion Criteria:
- positive shoulder impingement signs (positive Hawkins-Kennedy test and painful arc in
shoulder abduction or flexion)
- biceps tendonitis (positive Speed's test)
- adhesive capsulitis, or cervical radiculopathy
- a history of shoulder injury or surgery or orthopedic or neurologic disorders (other
than SCI) that would impact arm function
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